Oxidative stress may play a pivotal role in the pathophysiology of atrial fibrillation, the most common type of arrhythmia after cardiac surgery. Since N-acetylcysteine (NAC) is a free radical scavenger, it may attenuate this pathophysiologic response and reduce the incidence of postoperative atrial fibrillation (POAF). This meta-analysis was conducted to assess the efficacy of NAC supplementation on the prevention of POAF. Medline and Embase were systematically reviewed for studies published up to November 2011, in which NAC was compared with controls for adult patients undergoing cardiac surgery. Eight randomized trials (n = 578) were included and outcome measures included the incidence of POAF and hospital length of stay (LOS). NAC supplementation was found to significantly reduce the incidence of POAF (OR 0.62; 95% CI 0.41-0.93; P = 0.021) compared with controls, but had no effect on LOS (weighted mean difference 0.07; 95% CI 0.42-0.28; P = 0.703). The authors concluded that prophylactic NAC supplementation might effectively reduce the incidence of POAF but note that the overall quality of current studies is poor. Adequately powered randomized controlled trials with POAF incidence as a primary outcome measure are necessary before concrete conclusions can be made. BMC Cardiovasc Disord. 2012 Feb 24;12(1):10. PMID: 22364379
